For the most part, coverage and eligibility have not changed. Orthodontic treatment is available for children up to 21. If they are enrolled full-time at an accredited college or university, they are eligible up to 23.
Orthodontic treatment is available for active duty spouses and National Guard or Reserve members up to 23 years old. (National Guard and Reserve members should seek command approval before getting braces, since some devices can disqualify you for deployment readiness. If your unit is called up, you may be required to have the braces removed at your own cost.)
If your orthodontist is still in-network, you can continue treatment without interruption. One orthodontist we spoke with said that nothing would change for patients: “You won’t notice any difference. We will go through an additional step of filing liability papers on our end, but you can continue treatment and appointments without any interruption.”
Call your orthodontist now to confirm that they are remaining in network before the changes apply on May 1.
What if our orthodontist will no longer cover military families?
If your orthodontist is no longer accepting United Concordia, you are faced with a decision. You may continue to see the same orthodontist and pay out of network charges or you may change to a different orthodontist within the network. You will get the most coverage and pay the least out of pocket if you use a dentist within the network.
But beware of quality. One dentist from the TRICARE West region told us, “We won’t be able to accept United Concordia here because the percentages they are offering barely cover our overhead costs. I saw their list of in-network providers in the area, but there is not a single reputable dentist on that list. They are all corporate dentists with a revolving door, where the staff and dentists are always changing. We are torn, because we want to continue serving our families from the military base, but United Concordia needs to make a more reasonable offer.”
While stationed in the continental United States (CONUS), military families will be responsible for 50% of orthodontic fees. United Concordia will cover the other 50%, up to the annual and lifetime caps. The orthodontist must submit a schedule and an expected cost plan before braces are banded. United Concordia will pay 25% of their total share at the initial banding. The remaining 75% will be spread out over the rest of the expected visits.
Orthodontic treatments, like braces, has a lifetime cap of $1,750. (However, orthodontic diagnostics costs count towards the yearly $1,500 maximum benefit, not the orthodontic benefits.) Orthodontic treatment coverage includes placing the braces, regular visits and check-ups, adjustments, and measuring for a retainer (if needed). Insurance coverage does not include any repairs of broken devices, nor will they replace a lost or missing retainer.
If you or your child already had braces before the insurance changed to United Concordia, then their payments will be smaller in direct relation to the amount of time remaining for the orthodontic treatments. For example, if you already had braces for six months under the previous insurance (MetLife) and are expected to wear them for 18 more months, then United Concordia will assume 75% of the liability for covering the remaining procedures. They will split those costs 50-50 with you, and they will pay up to the annual or lifetime cap.
Braces are no longer free at overseas duty stations
If you are stationed overseas, there is now one less perk: Braces are no longer free. Patients are responsible for 50% of services, while United Concordia is liable for the other 50%. The biggest difference from CONUS payments is that when you live overseas, the government provides a cost-sharing benefit that pays the difference between United Concordia’s portion and the $1,750 max cap. This additional contribution from the government could save you thousands out of pocket.
Correction: Previously, we reported that the lifetime cap on orthodontics was $1,500. The correct number is $1750. We apologize for the error.
Lizann Lightfoot is an associate editor at Military One Click and a Marine Corps spouse. She can be reached at [email protected]